Overactive Bladder (OAB) is a common condition that significantly disrupts daily life, affecting an estimated 20% of the global population. It notably diminishes quality of life (QoL), impacting physical, emotional, and mental well-being. This study explores the psychological aspect of OAB, focusing on the role of catastrophizing urinary symptoms — a cognitive pattern characterized by an exaggerated negative outlook on urinary symptoms. This pattern, previously studied on pain, is known to increase pain perception and promote feelings of helplessness, thereby reducing QoL. Although research has typically associated catastrophizing with pain-related disorders, catastrophizing of urinary symptoms in patients with OAB and its effect on their QoL has not been previously examined. Our study seeks to address this gap by investigating how urinary-symptom-catastrophizing-thought-patterns in women with OAB affect their QoL, aiming to provide new insights into the complex relationship between psychological factors and this debilitating condition.

In this cross-sectional study, participants were recruited from a single tertiary urogynecology and pelvic floor outpatient clinic at Soroka University Medical Center, Beer Sheva, Israel. The exclusion criteria were active urinary tract infections, pregnancy, and being under 18 years of age. UI adjusted versions of the Pain Catastrophizing Questionnaire (uiPCS) and the Pain Self-Efficacy Questionnaire (PSEQ) were used to evaluate urinary symptom catastrophizing. The Pelvic Floor Disability Index (PFDI-20), Incontinence Impact Questionnaire (IIQ-7) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were used to evaluate QoL.
After recruitment, participants were divided into groups based on the median uiPCS scores to compare those with catastrophizing thought patterns to those without. Spearman’s correlation coefficient was used to explore the relationship between catastrophizing and QoL. Univariate analysis was conducted, followed by multivariable linear regression, to clarify the association between catastrophizing and QoL.

The median uiPCS score was 37. Forty-one patients scored below 37 and were allocated to the non-catastrophizing group, and were compared with 44 patients who scored ≥37 and were allocated to the catastrophizing group. Overall, the groups did not differ in most background characteristics including age, BMI, ethnicity, and menopausal status. Notably, in the catastrophizing group, the rate of patients adhering to medication therapy, was significantly higher (75% vs. 53.5%, p=0.04), as well as the number of episodes of urge urinary incontinence per week (median of 21 vs. 4, p<0.01, respectively). There was a significant difference between the groups in the total questionnaire scores. Specifically, the median IIQ-7 was found to be significantly higher among catastrophizing patients (13.00 vs. 2.00, p<0.01). When examining each question separately, catastrophizing patients scored significantly higher compared to non-catastrophizing ones. We found a significant positive correlation between the uiPCS and the IIQ-7 scores (Spearman's coefficient 0.60). Finally, after controlling for age and medication treatment for OAB, the linear regression model revealed a significant and positive relationship between QoL and catastrophizing scores controlling for age and treatment for OAB (p < 0.01). This effect was further substantiated by an unstandardized regression coefficient (B) of 0.302 (95% confidence interval 0.207-0.397), suggesting that as catastrophizing increases QoL is reduced. The median total questionnaire score for the PFDI-20 was also found to be higher in the catastrophizing group (24.0 vs. 18.0,

Our study reveals a significant association between pain catastrophizing and reduced QoL among women with OAB, hence those with higher levels of catastrophizing report more severe symptoms of OAB. This indicates that psychological factors, particularly the tendency to catastrophize urinary symptoms, play a substantial role in the perception and management of OAB symptoms, beyond the physical aspects of the condition.
The association between urinary-symptom-catastrophizing and reduced QoL scores, even after adjusting for factors like age and OAB medication treatment, highlights the need for a multifaceted approach to managing OAB that includes psychological support. The findings suggest that like with pain, by addressing urinary-symptom-catastrophizing, we could enhance treatment outcomes and improve the overall well-being of individuals with OAB.

This study underscores the critical role of psychological factors, specifically urinary-symptom-catastrophizing, on the QoL of patients with OAB. Our findings suggest the benefit that healthcare providers and patients may gain by incorporating psychological assessments and interventions into OAB management strategies. Addressing the cognitive and emotional aspects of urinary symptoms may lead to more comprehensive care, potentially improving both symptom management and patients' QoL. Future research should further explore the relationship between psychological factors and various aspects of OAB to develop holistic treatment approaches that cater to the physical and psychological needs of patients.